%0 Journal Article
%T Cortical injury in multiple sclerosis; the role of the immune system
%A Caroline A Walker
%A Anita J Huttner
%A Kevin C O'Connor
%J BMC Neurology
%D 2011
%I BioMed Central
%R 10.1186/1471-2377-11-152
%X Multiple sclerosis (MS) is widely viewed as a disease of white matter [1]. White matter lesions that include demyelination and neuronal damage are readily visible by MRI and macroscopically upon autopsy [2,3]. White matter lesions visualized via MRI are used to diagnose MS, in effect making these lesions the leading pathognomonic sign for MS [4]. The most widely accepted animal model, experimental autoimmune encephalomyelitis (EAE) in rodents, is based on an induced autoimmune reaction against myelin proteins of white matter of the central nervous system (CNS) [5]. That such injury is easily identifiable and ubiquitous, white matter pathology has been the subject of considerable attention. Although white matter damage is clearly present in the disease, it is not the only site within the CNS where the pathology of MS occurs. The cerebral cortex of the MS brain has recently been recognized as a major site of disease pathogenesis, perhaps now moving toward equal importance as the white matter. This is not to say that tissue damage in the cortex was never recognized. Gray matter damage has been described in MS since the earliest known reference to the disease phenotype. In Pathological Anatomy (1838), the Scottish pathologist Robert Carswell describes and illustrates a spinal cord that is viewed, by medical historians, to be among the very first documented cases of MS [6,7]. In this report Carswell notes the presence of lesions and atrophy. Regarding the grey matter damage, he writes, "The depth to which the medullary substance was affected in this matter varied from half a line to three or four lines, and on dividing the cord, it was seen to penetrate as far as the gray substance." His illustrations of the spinal cord's traverse sections demonstrate lesions exclusive to the white matter and those that have extended from the white into the gray matter. Although MS was not named a separate disease until 30 years later in Jean-Martin Charcot's Histology de la Sclerose en
%U http://www.biomedcentral.com/1471-2377/11/152